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Methylenedioxymethamphetamine (MDMA)-related fatalities in Australia: demographics, circumstances, toxicology and major organ pathology.

Sharlene Kaye, Shane Darke, Johan Duflou

Drug and Alcohol Dependence October 1, 2009 DOI: 10.1016/j.drugalcdep.2009.05.016 (opens in new tab)

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Characteristics Retrospective review Peer reviewed
Sample size 82
Population Decedents in Australia whose deaths were caused by MDMA, identified from the National Coronial Information System
Duration 5-year period
Topics MDMA
Key findings MDMA was the sole cause of death in 23% of 82 cases and a contributor in combined drug toxicity in 59%; 18% died primarily of disease or injury with MDMA as a contributing condition. Cardiovascular pathology was found in 58% of decedents, which the authors state is higher than expected among similarly aged members of the general population.

Abstract

To examine the demographic characteristics, circumstances, toxicology and major organ pathology of MDMA-related deaths in Australia. Retrospective review of cases in which MDMA was a cause of death, as identified from the National Coronial Information System. 82 cases over a 5-year period were identified. The majority of decedents were male (83%), with a median age of 26 years. Deaths were predominantly due to drug toxicity (82%), with MDMA the sole drug causing death in 23% of cases, and combined drug toxicity in 59% of cases. The remaining deaths (18%) were primarily due to pathological events/disease or injury, with MDMA a significant contributing condition. Cardiovascular pathology, typically atherosclerosis, was detected in 58% of decedents, with moderate-severe atherosclerosis in 23% of cases. The prevalence of such pathology is higher than that expected among similarly aged members of the general population. Cerebrovascular pathology, primarily cerebral haemorrhage and hypoxic damage, was present in 12% of cases. MDMA has contributed to a clinically significant number of deaths in Australia. The prevalence of cardiovascular pathology was similar to that among methamphetamine and cocaine fatalities. Whilst cardiovascular pathology may reflect the use of other stimulants, the cardiotoxic properties of MDMA have been well-documented. Future studies examining MDMA-related morbidity and mortality in the context of other risk factors are recommended. Overall, the current study highlights the need to educate users about the potential harms of MDMA use, particularly that in conjunction with other stimulants, opioids and alcohol, which are known to increase overall toxicity.

Comparable studies

Other observational and cohort studies on MDMA, most cited first.

Study Year Design Participants
Subjective Reports of the Effects of MDMA in a Clinical Setting Individuals who took MDMA in a clinical setting 1986 Observational study
Memory impairment in abstinent MDMA ("Ecstasy") users Abstinent MDMA users 1998 Observational cohort
Impaired cognitive performance in drug free users of recreational ecstasy (MDMA) Otherwise healthy young people 2000 Observational
The Psychological and Physiological Effects of MDMA on Normal Volunteers Older, more educated, drug-experienced individuals 1986 Observational cohort
Cognitive performance in recreational users of MDMA or 'ecstasy': evidence for memory deficits Young people who were regular or novice MDMA users, or non-users 1998 Observational cohort n = 30

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